Perioperative Landiolol Infusion Reduces the Incidence of Atrial Fibrillation after Pulmonary Lobectomy: Postoperative Randomized Controlled Study

Abstract

Background and Objective: Atrial fibrillation is a common complication after lung resection. We sought to determine the relationship between low-dose landiolol only intraoperatively administration and the incidence of atrial fibrillation development in patients who did not have atrial fibrillation before undergoing lung resection. Methods: Forty-five patients undergoing lung resection (lobectomy or bilobectomy), as indicated for lung cancer at Nippon Medical Hospital, between August 2012 and September 2013. Two patients were excluded from the final analysis. Patients were given either intravenous landiolol (n = 22) or placebo (n = 21) during lobectomy or bilobectomy only intraoperatively. This is prospective, randomized, placebo-controlled study. Main Outcome Measures: The primary end point was the incidence of sustained atrial fibrillation (≥30 min). Results: Postoperative atrial fibrillation occurred in 1 (4.5%) of the 22 patients in the landiolol group and 6 (28.6%) of the 21 patients in the placebo group. No serious adverse effects such as bradycardia and hypotention secondary to landiolol were observed. Conclusion: Low-dose landiolol infusion intraoperatively reduced the incidence of clinically significant atrial fibrillation in patients undergoing pulmonary lobectomy.

Landiolol for managing post-operative atrial fibrillation

“…Overall, low dose (from 2 to 5 mcg/kg/min) of landiolol infused during surgery 17 , 23 , 24 , 26–31 or immediately after surgery 25 , 32 consistently reduced significantly incidence of POAF by three-fold on average.…”

“…One study reported a low incidence of hypotension (3%) which resolved quickly upon reducing dose. 24 In general, most studies reported no bradycardia and no hypotension 17 , 24 , 30 , 31 or respiratory symptoms 26 with no need to decrease dose or stop the infusion.…”

“… 30 On the other hand, other case series reported high incidence probably due to recruiting elderly population which is associated with a higher risk of POAF (mean age of included patients developing POAF was 82 years). 17 …”

“…Right atrial volume overload and stretch accompanying increased pulmonary venous pressure or a vessel dissection following pulmonary resection are also believed to induce AF. 17 …”

“…Landiolol is a new ultra-short beta-blocker with a half-life of only 4 min and a high beta-1 selectivity which has been used for treatment and prevention of AF in pulmonary surgery 17 , 21–27 and gastro-intestinal surgery. 28–32…”